Medicaid Reimbursement Denied To Tribes With Dental Therapists

Swinomish Tribal Chairman Brian Cladoosby with Gov. Jay Inslee and state Sen. John McCoy after the signing of a bill allowing tribes to hire dental therapists

Ted S. Warren
/ AP Photo

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The federal government has denied a state request for tribes to qualify for Medicaid funding to pay for care done by mid-level providers known as dental health aide therapists. The Washington State Health Care Authority is appealing that decision.

Tribes were finally authorized to hire dental therapists in 2017 after a long battle in the state Legislature. But the Centers for Medicare and Medicaid Services has added a new road block, citing what’s known as the “free provider of choice” provision.

That essentially means if you want to receive Medicaid reimbursement for care, you must be provide said care to all Medicaid recipients. In this case, services by dental therapists are meant for tribal members only.

Even so, John Stephens, who is the senior health policy advisor with the Swinomish Tribe, contends that argument doesn’t work because dental therapists only add options of care and there’s no negative impact on anyone else. Plus, he says Medicaid reimbursements are badly needed to ensure the DHAT model is sustainable.

“Unfortunately, tribes are not fully funded to provide oral health services to their communities," he explained. "So adding a dental health aide therapist as a part of a provider team requires us to be able to reimbursed through third party billing, primarily Medicaid.”

Stephens says requesting additional funding through Indian Health Services would be time-consuming and it isn't a guarantee.

In a news release, Swinomish Tribal Chairman Brian Cladoobsy called the decision "a mistake." The Swinomish and several other tribes have backed the state's appeal to CMS.

If the appeal is denied, Stephens says the Swinomish are prepared to go to court. The Swinomish have been at the forefront of getting legislation passed to allow tribes throughout Washington state to be allowed to hire dental therapists.

The Port Gamble S'Klallam Tribe was the second to hire one of the mid-level providers.

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Access to dental care on reservations has been a problem for decades. In an effort to address the issue, Washington state gave tribes the go-ahead last year to hire mid-level providers known as “dental health aide therapists.”